American Academy of Pediatrics Chapter Quality Network Practice Improvement to Address Adolescent Substance Use Request for Applications (RFA) Application Deadline: July 15, 5:00PM CST www.aap.org/en-us/documents/cosa_piaasu_application.pdf Project Summary The American Academy of Pediatrics (AAP) is pleased to announce the launch of the Chapter Quality Network (CQN) Practice Improvement to Address Adolescent Substance Use (PIAASU) learning collaborative. The purpose of the PIAASU project is to improve care for adolescents with substance use and mental health concerns. The AAP will collaborate with 4 chapters to increase the use of validated screening tools, successful brief intervention techniques, and referral to treatment for substance use and mental health concerns among pediatric practices. Chapter and practice teams will have the opportunity to participate in a learning collaborative based on the Institute for Healthcare Improvement s Breakthrough Series Model, which includes a chapter leadership training at the AAP headquarters in Elk Grove Village, Illinois, 4 practice learning sessions, and monthly calls at both the chapter and practice levels. Chapter teams will be required to recruit 10-15 pediatric practices for the project. With coaching from the chapter project leadership, practices will systematically change their practice by repeatedly conducting small tests of change and collecting data (Plan-Do-Study-Act cycles). Practice participation will begin in December 2015 and continue through May 2017. Through participation in the project, chapter project leaders will form a community that works together to develop a new model of service for chapter members. Chapter project teams will expand their quality improvement (QI) knowledge, gain leadership skills, and develop their capacity to support member practices in QI efforts, therefore, increasing the value of membership. The 4 selected chapters will each receive a stipend of $30,000 to help defray the costs of undertaking this effort. Chapter participation will begin September 2015 and continue through June 2017. Additionally, the AAP, as an approved portfolio sponsor, will offer American Board of Pediatrics Maintenance of Certification (ABP MOC) Part 4 credit (if approved) to pediatricians who complete the requirements of this 2 year project. The AAP will also apply for 20 credits of Performance Improvement Continuing Medical Education (PI CME) for clinicians who complete the entire project (including presence at 4 learning sessions). The CQN PIAASU project will provide the selected chapters with tools, educational resources, technical support, and access to a data collection system to lead this QI effort. Support for the project includes access to the national AAP team, including a QI advisor and coach, who will assist practices in making system-based changes that improve care for adolescents with substance use and mental health concerns. The AAP national team includes the following positions: Principal Investigator holds primary responsibility for the design, execution, and management of the project.
Project Advisory Committee pediatricians with expertise in substance use and mental health care who help guide clinical practice changes. Quality Improvement Advisor provides direction and guidance for overall design of the project. Supports chapters and practices throughout practice transformation. Quality Improvement Coach supports chapters and practices throughout practice transformation and coaches them as they learn to implement QI tools and resources. Quality Improvement Data Aggregator Manager responsible for data analysis (monthly data reports at the practice, chapter, and national level for the project. Project Manager responsible for overall direction of project, management of day-to-day project activities, and budget. As mentioned above, the project provides access to a data collection tool called the Quality Improvement Data Aggregator (QIDA). QIDA is a Web-based system that collects, collates, and reports QI data for multiple QI projects. Each participating chapter will be expected to form and manage a chapter project leadership team that includes a physician project leader, a chapter project manager and a local substance use or mental health expert who will develop a learning community amongst recruited practices and build a sustainable QI infrastructure within the chapter. The 10-15 participating practices will be asked to identify a QI team and develop practice-specific improvement goals to help focus their efforts to improve substance use and mental health care for adolescents. To be successful, each chapter team will be required to meet the chapter expectations outlined on pages 8-9 of this RFA. Practice expectations are included, as well. This opportunity for chapters is made possible by generous support from the Conrad N. Hilton Foundation. 2
Chapter Quality Network PIAASU Project Timeline* Month June 2015 July 2015 Month August 2015 September 2015 October 2015 November 2015 December 2015 January 2016 February 2016 March 2016 April 2016 May 2016 June 2016 July 2016 Application Activity Release Request for Application for all chapters June 3 Informational conference calls June 9, June 11 Deadline for application submission July 15 Announcement of selected PIAASU chapters on or before July 31 Project Activity Teleconferences for selected PIAASU chapters Week of August 10 Contracts distributed to PIAASU chapters 4 chapter contracts executed Chapter enrollment package distributed Practice recruitment packages distributed Chapter leadership calls begin (#1) Chapter leadership training held (1.5 day meeting) Date September 29 th & 30th Begin practice recruitment Continue practice recruitment Practice enrollment (includes consent to participate) Pre-work assigned/baseline data collected Practice pre-work calls Chapter leadership call (#2) Learning session 1 (face-to-face) for 2 chapters Learning session 1 (face-to-face) for 2 chapters Data collection begins Chapter leadership call (#3) Practice calls (#1) 2 nd month of data collection Chapter leadership call (#4) Practice calls (#2) 3rd month of data collection Chapter leadership call (#5) Practice calls (#3) 4th month of data collection Chapter leadership call (#6) Practice calls (#4) 3
August 2016 September 2016 October 2016 November 2016 December 2016 January 2017 February 2017 March 2017 April 2017 May 2017 June 2017 5th month of data collection Chapter leadership call (#7) Practice calls (#5) Learning Session 2 held via Webinar (all 4 chapters separately) 6th month of data collection Chapter leadership call (#8) Practice calls (#6) 7th month of data collection Chapter leadership call (#9) Practice calls (#7) Learning Session 3 (face-to-face) for 2 chapters 8th month of data collection Chapter leadership call (#10) Practice calls (#8) Learning Session 3 (face-to-face) for 2 chapters 9th month of data collection Chapter leadership call (#11) Practice calls (#9) 10th month of data collection Chapter leadership call (#12) Practice calls (#10) 11th month of data collection Chapter leadership call (#13) Practice calls (#11) 12th month of data collection Chapter leadership call (#14) Practice calls (#12) Learning Session 4 via Webinar (all 4 chapters separately) Chapter leadership call (#15) Practice calls (#13) Chapter leadership call (#16) Practice calls (#14) Project closeout *Dates subject to change 4
Application Process The CQN PIAASU Project application process will be conducted in 2 phases involving: 1) the completion of an application and 2) if selected, participation in one conference call between your chapter s physician project leader and chapter project manager, and the national AAP leadership team members. Application Phase I: Complete application During the first phase, interested chapters will complete an application detailing their ability to lead and participate successfully in the CQN PIAASU Project. Applications are due to the AAP on Wednesday, July 15, 2015, by 5:00PM CST. Please send your application with signatures (electronic signatures are acceptable), to: Stephanie Domain, Manager, Mental Health Initiatives Email: sdomain@aap.org Fax: 847/228-7320 Late applications will not be accepted. Informational calls will be held on: Tuesday, June 9, 2015 12PM-1PM CST / 1PM-2PM EST Thursday, June 11, 2015 12PM-1PM CST / 1PM-2PM EST Please use the following call-in number and pass code to participate: Dial-In: 1-877-273-4202 Conference Room Code: 9108612 GoToMeeting Webinar Link: https://global.gotomeeting.com/join/553945277 The final 4 chapters will be announced on or before July 31 st. All applicants will be notified of the decision via email. Application Phase II: Participate in one conference call with the national AAP leadership team Chapters with the highest scoring applications will be asked to participate in the PIAASU project and asked to attend a conference call between your chapter s physician project leader and chapter project manager, and the national AAP leadership team members. The purpose of the call is to provide the national AAP leadership team and chapter applicants with an opportunity to discuss the project in detail and answer questions. The conference calls are tentatively scheduled to take place the week of August 10 th. Chapters selected to participate in the phase II conference calls will be notified of their specific call time/date and additional details by August 3 rd. When submitting your applications, please be mindful of these dates in the event that your chapter team is selected to participate in the conference call. 5
Application Components The application is organized into the following sections: 1. Identification of a chapter project leadership team including: Physician Project Leader (with time to lead the project and attest to individual pediatrician participation) Chapter Project Manager Local Substance Use and/or Mental Health Expert 2. Chapter infrastructure for QI demonstrated by: Active chapter QI committee with strong leadership QI activities are included in chapter strategic plan 3. Experience with leading QI in practice 4. Effective communication processes between chapter leadership and members 5. Experience providing CME programs 6. Plan describing methods to recruit 10 to 15 practices 7. Evidence of partnerships with state programs, payers, and other organizations interested in advancing child health quality 8. Chapter goals and expectations 9. Evidence of financial controls Please consider the following information when completing the CQN application: Identification of chapter project leadership team The CQN PIAASU Project requires participating chapters to form and manage a chapter project leadership team that will develop a sustainable improvement infrastructure and support practices in improving substance use and mental health care. Each chapter team should include: 1) a physician project leader, 2) a chapter project manager, and 3) a local substance use and/or mental health expert. The chapter team fills a dual role: 1) work within the chapter by managing the learning collaborative of 10-15 member practices and 2) work with the other selected chapters to create a community to share learnings. Physician Project Leader The physician project leader will lead the project at the chapter level and attest to the participation of each individual pediatrician involved in the chapter project. This person must be a member of both the national AAP and the chapter. It is recommended that the physician project leader be a current or past practicing pediatrician with leadership skills and time to lead the project. Experience in and enthusiasm for QI are important. This person can be an existing chapter officer, immediate past chapter officer, and/or a champion for chapter QI efforts. It is estimated that the physician project leader will devote approximately 3 to 5 hours a week to this project. 1 Chapter Project Manager The chapter project manager will be responsible for conducting the day-to-day activities of the project. It is recommended that the chapter project manager have experience with managing chapter projects and grants, organizing large meetings, and working with member practices. Once participating chapters have been identified, this person must be ready to manage the project. It is estimated that the chapter project manager will devote approximately 16 to 20 hours a week to this project. 1 6
Local Substance Use and/or Mental Health Expert The local substance use and/or mental health expert will provide the clinical substance use and mental health expertise for the chapter and participating practices. The substance use and mental health expert will be responsible for attending and presenting at learning sessions and answering clinical questions via listserv and on conference calls/webinars, as needed. The expert will need to be available for chapter team planning meetings. Chapter Infrastructure for Quality Improvement (Application Questions 1-16) Experience with QI in practice (questions 3-4) Please complete these questions pertaining to the chapter s experience with QI in practice. QI in practice refers to activities that use data-based methods to bring about rapid improvements in health care delivery. Please provide a maximum of 3 examples for question 3a. Communication between Chapter Leadership & Members (questions 5-6) Please describe your chapter s communication processes. CME Experience (question 7) Please describe your chapter s experience offering CME programs. Practice Recruitment (questions 8-10) Question 8: Please paint a picture of the practice composition within the state or chapter. In the brief description, provide the approximate percentage of small practices, large group practices, large networks, academic centers, etc. within the state or chapter. Questions 9 and 10: Chapters selected to participate in the CQN PIAASU project are required to identify 10 to 15 practices to participate in the learning collaborative. The practice selection questions pertain to how you intend to recruit practices, as well as the demographics of the practices you intend to recruit. Evidence of partnerships with state or private partners (question 11) Provide a maximum of 3 examples when listing the organizations with which you have a productive working relationship (ie, the agency calls upon the chapter for participation to improve children s health care). Please consider those organizations that the chapter has partnered with that directly impact the work and policy affecting children s health care quality (ie, Medicaid, payers, universities, state health departments, Title V, integrated delivery systems). Describe your relationship with family consumer groups (ie, Family Voices, National Alliance for Mental Illness, Federation of Families for Children s Mental Health, etc) Chapter Goals & Expectations (questions 12-13) Please complete these questions pertaining to the chapter s goals and expectations from the project. Evidence of Financial Controls (question 14) Please complete the question about your chapter having a written policy/procedure in place for financial grant management. Application Guidelines Submitting letters of support with the application is not required. 7
Submitted applications cannot exceed a maximum of 8 pages (not including letters of support). 8
Chapter Quality Network PIAASU Project Chapter & Practice Expectations Expectations of Chapters Participate in the entirety of the CQN PIAASU project through June 2017. Develop a chapter project leadership team that includes (at a minimum) a physician project leader, a chapter project manager, and a local substance use and/or mental health expert, as described on pages 6-7 of this document. This team will be responsible for managing key components of the learning collaborative. Attend the 1.5-day chapter leadership training in Elk Grove Village, Illinois, in September 29-30, 2015. Recruit 10-15 diverse practices. Identify local substance use and mental health resources for patient/family education. Coordinate and lead 4 learning sessions. Learning sessions are large learning events that your chapter will organize and host for participating member practices. There will be a total of 4 learning sessions throughout the project and these will be held within the month/year based on the project timeline set forth by the AAP. The entire chapter team is expected to attend all 4 sessions. Two of these sessions will be face-to-face and involve all 10 to 15 of your chapter s practice teams in a day-long meeting in your state. The chapter will be responsible for coordinating and managing these face-to-face meetings. The 2 additional learning sessions will be held via webinar, which the national office will coordinate. Learning session content and materials will be developed by the chapter leaders with ongoing consultation from the national AAP leadership team including the PAC, QI advisor, and QI coach. PI CME for completion of the project (including the 4 learning sessions) will also be coordinated by the AAP. Participate in monthly chapter leadership calls with the national leadership team and other chapters to share learnings and data. Once a month, the physician project leader and project manager will attend a conference call with the teams from the other participating chapters and the national project staff. The purpose of this meeting is to review the chapters data, troubleshoot problems that the chapters encounter, and share strategies for the continuous building of chapter infrastructure. Other team members may attend these meetings as available. Support practices by facilitating monthly practice conference calls and email listservs throughout the project. Specifically, the physician project leader will co-lead conference calls. Once a month, the physician project leader will co-lead, with assistance from the national QI coach, a conference call with all of the participating practice teams. The topics of these meetings will vary; however, the general agenda will include the review of monthly data, troubleshooting problems that teams encounter, and highlighting 9
teams that are doing exceptionally well. The entire chapter team should attend these meetings. Coordinate the practices submission of data and narrative reports to track improvement. Chapter teams will take responsibility for practice data by sending monthly email reminders, communicating with practices with low data submission, and congratulating practices who succeed at this activity. The national QI coach will assist chapters with the format of monthly email reminders. Coach practice teams with support from the national QI coach. Chapter teams, especially the physician project leader, will coach practices throughout their improvement with the support of the national QI coach. Coaching includes reviewing and analyzing data, encouraging practices to make changes in their practice, persuading them to move out of their comfort zone, and taking responsibility for their successes and failures. Through coaching, the chapter team will drive practice outcomes. Complete all activities outlined in the Chapter Key Driver Diagram. Chapters will be expected to make changes that increase their current infrastructure for QI. The Chapter Key Driver Diagram will serve as a guide for managing the learning collaborative and provide tools and templates for making QI activities sustainable at the chapter level. Recruit support from key stakeholders, including payers, hospitals, and health systems. Monitor practice improvement activity and provide feedback about each physician s meaningful participation required for ABP MOC Part 4 credit. The physician project leader will be responsible for attesting that individual physicians have participated in the CQN PIAASU project and completed its requirements. Develop and implement strategies to sustain practice engagement in measurement and improvement activities after formal learning concludes. Expectations of Practices Form a core QI team with at least 3 members. These members must include: a physician leader; a nurse, nurse practitioner or medical assistant; and administrative staff or an office manager. One member is asked to commit to being the day-to-day team contact. Complete the work outlined in the CQN PIAASU pre-work packet. Attend and participate in all 4 learning sessions, as described above. Attend monthly conference calls with other participating practices to review data and share best practices. At a minimum, the core team must meet twice a month to plan and carry out tests of change. 10
Complete all activities outlined in the Practice Key Driver Diagram. This requires a willingness to build QI into practice activities. Practices will be expected to engage in small tests of change (ie, using planned care templates, practice protocols and self-management strategies) affecting their office system to make improvements in the care delivered to adolescents with substance use and mental health concerns. Utilize QIDA for data collection. The QIDA Web-based system allows practices to manage the care of adolescents with substance use and mental health concerns. The user-friendly system generates real-time data reports for practices to provide feedback on performance. Engage and partner with families. Physician practice leaders are expected to attest to other physicians meeting participation requirements for ABP MOC Part 4 credits. 1 Please note these numbers serve as only an estimate to the amount of time the Physician Project Leader and Chapter Manager will commit to the CQN PIAASU project. Actual FTE will differ between participating chapters. 11